Below are meeting notes from the June 26 THCIC Data Collection Workgroup meeting. Notes provided by Department of State Health Services staff.
1) Introductions – Bruce Burns introduce himself and had the members in the room and online introduce themselves.
2) Data System Updates
a) System13, Inc. upgrade (May 19, 2014). Tom Phelps reported that the data receiving component and checking process were combined. This allowed the system to immediately pick up submitted files from the data receiving station. The system then checks the file for formatting compliance using an enhanced auditing and messaging components. He stated that the enhanced system would provide up to 5 error messages regarding file format issues and would also provide up to 5 FYI messages on potential problems with the file and/or data (such as missing data segments or data elements).
b) System13, Inc. upgrade (June 16, 2014) Mr. Phelps stated that System13, Inc.’s internal software was upgraded and tested. There seems to be an intermittent issue regarding the display of the certification data sets. The Certification webpage is designed to display the Inpatient Certification files on the Left half of the page and the Outpatient on the Right half of the page. Sometimes when the user opens the Certification page the Inpatient files appear on the Right half of the page and the Outpatient certification files do not appear. This has shown to be corrected by refreshing the page. This issue appears independent of the tested browsers (Mozilla and Internet Explorer). System13, Inc. will continue to investigate the issue to correct this.
3) Rules:
a) Hospital Emergency Department Data and Rural Provider Exemption Repeal
i) Rules were published in the Texas Register May 2, 2014 (39 TexReg 3553- 3565).
ii) The comment period ended June 2, 2014. Three sets of comments were received
ii) The comment period ended June 2, 2014. Three sets of comments were received
(1) One commenter asked about what the department was going to do since ICD-10 was delayed until October 1, 2015. The department still intends to begin collecting data as proposed in January 1, 2015. So the first deadline for data submission would be June 1, 2015.
(2) One commenter asked to have the Physician Assistants added to the list of definition under “Other Health Professional” listing. This is proposed to be added to the language to be adopted, since it is not a substantial change to the rules.
(3) Two commenters recommended being lenient on fining the rural facilities. THCIC has been lenient with fining facilities. Program staff do contact and provide assistance to the best of their ability to help the facility submit their data. The program is more interested in getting the data than fining the facility.
(4) Two commenters suggested that the DSHS should not implement all components of the proposed rules and amend rules at the same time. The department at this time does not anticipate stagger or delaying certain components of the rules. The data format is compatible with their claims data; therefore the facilities could submit their data from their billing system. Also the first quarter 2015 submission deadline is June 1, 2015.
(2) One commenter asked to have the Physician Assistants added to the list of definition under “Other Health Professional” listing. This is proposed to be added to the language to be adopted, since it is not a substantial change to the rules.
(3) Two commenters recommended being lenient on fining the rural facilities. THCIC has been lenient with fining facilities. Program staff do contact and provide assistance to the best of their ability to help the facility submit their data. The program is more interested in getting the data than fining the facility.
(4) Two commenters suggested that the DSHS should not implement all components of the proposed rules and amend rules at the same time. The department at this time does not anticipate stagger or delaying certain components of the rules. The data format is compatible with their claims data; therefore the facilities could submit their data from their billing system. Also the first quarter 2015 submission deadline is June 1, 2015.
b) The rules are in process of being reviewed by DSHS Executive Leadership and once approved will be forwarded to HHSC for approval to be adopted. The rules need to be adopted and published before October 1, 2014 in order to implement the rules effective January 1, 2015. This is due to Health and Safety Code, §108.009(b) which requires the department to adopt the rule at least 90 days prior to implementation.
4) SB 7 (82nd First Called) Section Potentially Preventable Readmissions/Complications Reports
a) Training with 3M occurred on Friday June 13, 2014 for both PPC and PPR
b) Potentially Preventable Complications (PPC)
i) Hongyun Dong is currently working on this report.
ii) Upgrading to the 2014 version, waiting on IT to install upgraded software.
iii) 3M tested one record in the new version and ran with no error. Running in the older version creates debug messages.
ii) Upgrading to the 2014 version, waiting on IT to install upgraded software.
iii) 3M tested one record in the new version and ran with no error. Running in the older version creates debug messages.
c) Potentially Preventable Readmissions (PPR)
i) Tunu Loponi is currently working on this report.
ii) Upgrading to the 2014 version, waiting on IT to install upgraded software.
ii) Upgrading to the 2014 version, waiting on IT to install upgraded software.
5) ICD-10-CM and ICD-10-PCS Implementation Plan
a) HR 4302 was signed by President Obama, this delays of implementation of ICD-10-CM/PCS codes to not before October 1, 2015. HHSC and DSHS are still looking at implications, since some funding through the Affordable Care Act may not be available due to the delay. This is still being discussed at HHSC and DSHS.
b) Under the current contract the System13, Inc. will update the data collection, processing and transfer components to accommodate ICD-10CM/PCS codes effective October 1, 2015. Therefore all claims data submitted with a discharge date or outpatient service date on or after October 1, 2015 will need to contain ICD-10 codes where appropriate. All claims with dates prior to October 1, 2015 should remain with ICD-9-CM codes. Mr. Phelps stated that since the deadline for the fourth quarter 2015 file submission is not until March 1, 2016. There is time that facilities could test their system between the October 1, 2015 and the March 1, 2016 submission deadline.
b) Under the current contract the System13, Inc. will update the data collection, processing and transfer components to accommodate ICD-10CM/PCS codes effective October 1, 2015. Therefore all claims data submitted with a discharge date or outpatient service date on or after October 1, 2015 will need to contain ICD-10 codes where appropriate. All claims with dates prior to October 1, 2015 should remain with ICD-9-CM codes. Mr. Phelps stated that since the deadline for the fourth quarter 2015 file submission is not until March 1, 2016. There is time that facilities could test their system between the October 1, 2015 and the March 1, 2016 submission deadline.
6) Quality of Care Reports
a) The review and comment period for the Quality of Care reports (not using diagnosis present on admission (POA) indicators) ended June 6, 2014. These reports are comparable to the previous Quality Indicator reports, which also did not include POA.
b) THCIC staff are reviewing the comments and preparing the reports for public display on the THCIC website.
b) THCIC staff are reviewing the comments and preparing the reports for public display on the THCIC website.
i) Inpatient Quality Indicators (IQI)
ii) Pediatric Quality Indicators (PDI)
iii) Patient Safety Indicators (PSI)
ii) Pediatric Quality Indicators (PDI)
iii) Patient Safety Indicators (PSI)
(1) This will be the first release publicly for these PSI indicators.
(2) Last year the Data Collection Workgroup reviewed the PSI report and did not find any objections for reporting the information.
(2) Last year the Data Collection Workgroup reviewed the PSI report and did not find any objections for reporting the information.
c) THCIC staff has run the data for the IQI, PDI and PSI using the POA indicators and sent out notices for the passwords and codes for the affected facilities to review.
i) The notifications of the review went out Wednesday June 25, 2014.
ii) Notices of reports went only go to those facilities that are listed in the reports. Most CMS POA exempted facilities (Psych, Rehab, Critical Access Hospitals, Cancer, and Long Term Acute Care) are eliminated from the report.
ii) Notices of reports went only go to those facilities that are listed in the reports. Most CMS POA exempted facilities (Psych, Rehab, Critical Access Hospitals, Cancer, and Long Term Acute Care) are eliminated from the report.
iii) THCIC did included the Children’s hospitals,
(1) Pediatric hospitals are exempt by CMS from POA submission, but THCIC has received notifications that from at least one children’s hospital that said they would be submitting the POA indicators. They stated that reporting this information helps to demonstrate the severity of the children they treat.
(2) DSHS reviewed the data and at least two Children’s hospitals did submit POA on their claims data records to THCIC. These facilities are included in the reports to be reviewed.
(3) THCIC staff will look at the reports and review the comments from the facilities regarding the Children’s hospitals and will make a determination on whether these should be included in the public reports.
(2) DSHS reviewed the data and at least two Children’s hospitals did submit POA on their claims data records to THCIC. These facilities are included in the reports to be reviewed.
(3) THCIC staff will look at the reports and review the comments from the facilities regarding the Children’s hospitals and will make a determination on whether these should be included in the public reports.
iv) The review period will start June 30, 2014 and run through September 2, 2014.
7) MONAHRQ – My Own Network Agency for Healthcare Research and Quality
a) This is a software tool created by AHRQ to allow hospital discharge data to be displayed easily and quickly by states in standardized format. http://monahrq.ahrq.gov/
b) Several other states use this tool: Arizona, Arkansas, Hawaii, Indiana, Kentucky, Maine, Nevada, Oklahoma, Utah, Vermont, Virginia and Washington.
c) MONAHRQ uses the publicly available data from THCIC public use Inpatient Data file (reformatted for MONAHRQ), CMS Hospital Compare data file and CMS HCAHPS survey measures (patient survey data) and the software produces a website that displays:
b) Several other states use this tool: Arizona, Arkansas, Hawaii, Indiana, Kentucky, Maine, Nevada, Oklahoma, Utah, Vermont, Virginia and Washington.
c) MONAHRQ uses the publicly available data from THCIC public use Inpatient Data file (reformatted for MONAHRQ), CMS Hospital Compare data file and CMS HCAHPS survey measures (patient survey data) and the software produces a website that displays:
i) Quality of care at the hospital level,
ii) Health care utilization at the hospital and emergency department level
iii) Preventable hospitalizations at the area level, and
iv) Rates of conditions and procedures at the area level.
v) Estimated costs and cost-savings related to the quality of care
ii) Health care utilization at the hospital and emergency department level
iii) Preventable hospitalizations at the area level, and
iv) Rates of conditions and procedures at the area level.
v) Estimated costs and cost-savings related to the quality of care
d) THCIC staff is providing the Inpatient Public Use Data Files (PUDF) for this CHS project. The project is being implemented by another analytics and technical group within CHS. THCIC staff is consulting with this group in regards to the THCIC data and the Quality Indicators.
e) Some of the quality measures that THCIC does not produce are to be removed from display in MONAHRQ.
f) The data and projects are and have been reviewed by a MONAHRQ review team within CHS.
g) The DSHS Implementation Date is scheduled to occur on July 11, 2014. Two years of data (2011 and 2012) are to be made available on separate versions of MONAHRQ. Thus two separate websites. (MONAHRQ does not currently provide for multiple datasets to be viewed in one version of MONAHRQ.
h) This is in part to address the Sunset Review Commission report recommendations to provide more consumer information.
e) Some of the quality measures that THCIC does not produce are to be removed from display in MONAHRQ.
f) The data and projects are and have been reviewed by a MONAHRQ review team within CHS.
g) The DSHS Implementation Date is scheduled to occur on July 11, 2014. Two years of data (2011 and 2012) are to be made available on separate versions of MONAHRQ. Thus two separate websites. (MONAHRQ does not currently provide for multiple datasets to be viewed in one version of MONAHRQ.
h) This is in part to address the Sunset Review Commission report recommendations to provide more consumer information.
8) Other Topics
a) The Sunset Review Commission (SRC) released its report regarding DSHS (available on the Sunset Review Commission’s website).
i) The report addresses THCIC on Issue #7.
ii) The SRC report stated that there is a need for the continuance of the data collected under Chapter 108. The data does fill a gap, since it collects data not collected elsewhere. For example Self Pay, uninsured and from all third party payers. Not stated in the meeting: The SRC report also noted the program should be evaluated on how its functions fit within the broader health and human services system.
iii) The SRC report recommended that the DSHS needed to a better job on displaying data and information for consumers.
ii) The SRC report stated that there is a need for the continuance of the data collected under Chapter 108. The data does fill a gap, since it collects data not collected elsewhere. For example Self Pay, uninsured and from all third party payers. Not stated in the meeting: The SRC report also noted the program should be evaluated on how its functions fit within the broader health and human services system.
iii) The SRC report recommended that the DSHS needed to a better job on displaying data and information for consumers.
b) One question was asked about the testing of claims with ICD-10 codes. Tom Phelps stated that their testing system mirrors the productions system; therefore the test system would only be able to start testing the ICD-10 coded claims when they change the production system over. Mr. Phelps stated that since the system accepts a HIPAA compatible ANSI 837 5010 institutional and professional claims, the providers could test on other available Health Plan test sites. He also stated that since the deadline for the fourth quarter 2015 file submission is not until March 1, 2016. There is time that facilities could test their system between the October 1, 2015 and the March 1, 2016 submission deadline.
Next meeting – Tentatively Tuesday, September 23, 2014